Schedule 1

Forms

In force

[Heading inserted: SL 2025/35 r. 15.]

[Form 1 deleted: Gazette 14 Oct 2005 p. 4558.]

Form 2

[Regulation 9(2)]

Casino Control Act 1984

Casino Control (Burswood Island) (Licensing of Employees) Regulations 1985

CASINO KEY EMPLOYEE LICENCE

Licence No. ..........................................

Gaming and Wagering Commission of Western Australia

.................................................................................................................................

whose photograph and signature appear hereunder is hereby licensed as a Casino Key Employee under the Casino Control (Burswood Island) (Licensing of Employees) Regulations 1985.

Issued at ............................., this ..................... day of ........................... 20...........

........................................................................

Chief Casino Officer

Gaming and Wagering Commission of

Western Australia

[Form 2 amended: Gazette 4 May 1990 p. 2243; 30 Jan 2004 p. 414; 24 Jun 2005 p. 2773.]

Form 3

[Regulation 9(2)]

Casino Control Act 1984

Casino Control (Burswood Island) (Licensing of Employees) Regulations 1985

CASINO EMPLOYEE LICENCE

Licence No. ..........................................

Gaming and Wagering Commission of Western Australia

.................................................................................................................................

whose photograph and signature appear hereunder is hereby licensed as a Casino Employee under the Casino Control (Burswood Island) (Licensing of Employees) Regulations 1985.

Issued at ............................., this ..................... day of ........................... 20...........

........................................................................

Chief Casino Officer

Gaming and Wagering Commission of

Western Australia

[Form 3 amended: Gazette 4 May 1990 p. 2243; 30 Jan 2004 p. 414; 24 Jun 2005 p. 2773.]

Form 4

[Regulation 12]

Casino Control Act 1984

Casino Control (Burswood Island) (Licensing of Employees) Regulations 1985

NOTIFICATION OF COMMENCEMENT OF EMPLOYMENT OR WORK

TO: Chief Casino Officer

Gaming and Wagering Commission of Western Australia

I, .............................................................................................................................

(full name)

being .......................................................................................................................

(position held)

for and on behalf of ................................................................................................

(Operator)

hereby advise that ..................................................................................................

(name of licensee)

the holder of a * Casino Key Employee Licence/Casino Employee Licence No. .............................. commenced * duty as such employee/working with permission of the Operator

on ............................................................................................................................

Dated .................................................................................................... 20.............

Signature .....................................................

* Strike out whichever is inapplicable.

[Form 4 amended: Gazette 4 May 1990 p. 2243; 30 Jan 2004 p. 414.]

Form 5

[Regulation 18]

Casino Control Act 1984

Casino Control (Burswood Island) (Licensing of Employees) Regulations 1985

NOTIFICATION OF TERMINATION OR CESSATION OF EMPLOYMENT OR WORK

TO: Chief Casino Officer

Gaming and Wagering Commission of Western Australia

I, .............................................................................................................................

(full name)

being .......................................................................................................................

(position held)

of ............................................................................................................................

(Operator)

hereby notify in respect of .....................................................................................

(full name of employee)

the holder of a * casino key employee licence/casino employee licence No. ....... that as from ................................... 20..............

* the Operator has terminated the employment of the employee

* the employee has * terminated the employment/ceased working with the Operator

* the employee has ceased to be an employee of the Operator.

Reasons for termination or cessation of employment or work are —

...................................................................................................................................................................................................................................................................................................................................................................................................

Dated ...................................................................... 20.............

............................................................................

Signature.

* Strike out whichever is inapplicable.

[Form 5 amended: Gazette 4 May 1990 p. 2243; 30 Jan 2004 p. 414.]

Form 6

[Regulation 19]

Casino Control Act 1984

Casino Control (Burswood Island) (Licensing of Employees) Regulations 1985

PROVISIONAL CASINO KEY EMPLOYEE LICENCE

Licence No.: P.............................

Gaming and Wagering Commission of Western Australia

.................................................................................................................................

whose photograph and signature appear hereunder is hereby provisionally licensed as a Casino Key Employee under the Casino Control (Burswood Island) (Licensing of Employees) Regulations 1985.

Issued at ............................., this ..................... day of ........................... 20..........

This Provisional Licence is valid until ...................................................................

Extended to ............................................................................................................

............................................................

Chief Casino Officer

Gaming and Wagering Commission of

Western Australia.

[Form 6 amended: Gazette 4 May 1990 p. 2243; 30 Jan 2004 p. 415; 24 Jun 2005 p. 2773.]

Form 7

[Regulation 19]

Casino Control Act 1984

Casino Control (Burswood Island) (Licensing of Employees) Regulations 1985

PROVISIONAL CASINO EMPLOYEE LICENCE

Licence No.: P.................................

Gaming and Wagering Commission of Western Australia

.................................................................................................................................

whose photograph and signature appear hereunder is hereby provisionally licensed as a Casino Employee under the Casino Control (Burswood Island) (Licensing of Employees) Regulations 1985.

Issued at ............................., this ..................... day of ........................... 20..........

This Provisional Licence is valid until ..................................................................

Extended to ............................................................................................................

.............................................................

Chief Casino Officer

Gaming and Wagering Commission of

Western Australia.

[Form 7 amended: Gazette 4 May 1990 p. 2243; 30 Jan 2004 p. 415; 24 Jun 2005 p. 2773.]

Form 8 — Infringement notice

[r. 21(1)]

Casino Control Act 1984 INFRINGEMENT NOTICE			Infringement notice no.
Alleged offender	Name

	Address

Alleged offence	Date or period
	Time
	Place
	Details of offence

	Written law contravened

Modified penalty	$
Date	Date of notice
Issuing officer	Name
	Signature
TAKE NOTICE	It is alleged that you have committed the above offence. If you do not want to be prosecuted in court for the offence, pay the modified penalty to the Approved Officer (the Gaming and Wagering Commission) within 28 days after the date of this notice. If you do not pay the modified penalty within 28 days after the date of this notice, you may be prosecuted or enforcement action may be taken under the Fines, Penalties and Infringement Notices Enforcement Act 1994. Under that Act, some or all of the following action may be taken — your driver’s licence may be suspended, your vehicle licence may be suspended or cancelled, you may be disqualified from holding or obtaining a driver’s licence or vehicle licence, your vehicle may be immobilised or have its number plates removed, your details may be published on a website, your earnings or bank accounts may be garnished, and your property may be seized and sold. If you need more time to pay the modified penalty, you should contact the Gaming and Wagering Commission at the address below. Paying the modified penalty will not be regarded as an admission for the purposes of any civil or criminal court case. If you want this matter to be dealt with by prosecution in court, sign and date here: __________________________________ / / and post this notice to the Gaming and Wagering Commission at the address below within 28 days after the date of this notice.
How to pay	By post	[Insert details for paying by post]
	In person	[Insert details for paying in person]
	Electronically	[Insert details for paying electronically]

[Form 8 inserted: SL 2025/35 r. 16.]

Form 9 — Withdrawal of infringement notice

[r. 21(2)]

Casino Control Act 1984 WITHDRAWAL OF INFRINGEMENT NOTICE		Withdrawal no.
Alleged offender	Name

	Address

Details of infringement notice	Infringement notice no.
	Date of issue
Alleged offence	Date or period
	Time
	Place
	Details of offence

	Written law contravened

Officer of the Commission withdrawing notice	Name
	Signature
Date	Date of withdrawal
Withdrawal of infringement notice	The above infringement notice issued against you for the above alleged offence has been withdrawn. If you have already paid the modified penalty for the alleged offence, you are entitled to a refund. [Insert details for processing of refund.]

[Form 9 inserted: SL 2025/35 r. 16.]

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